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NATIONAL GUIDELINES for the TREATMENT of MALARIA, SOUTH AFRICA 2018 GUIDELINES for the TREATMENT of MALARIA in SOUTH AFRICA 2018 Update

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NATIONAL GUIDELINES for the TREATMENT of MALARIA, SOUTH AFRICA 2018 GUIDELINES for the TREATMENT of MALARIA in SOUTH AFRICA 2018 Update NATIONAL GUIDELINES FOR THE TREATMENT OF MALARIA, SOUTH AFRICA 2018 GUIDELINES FOR THE TREATMENT OF MALARIA IN SOUTH AFRICA 2018 update Contents Preface .................................................................................................................................................................. 4 Acknowledgements ............................................................................................................................................. 5 Abbreviations ....................................................................................................................................................... 6 Disclaimer ............................................................................................................................................................. 6 Summary ............................................................................................................................................................... 7 Approach to management ................................................................................................................................................. 7 Confirm diagnosis and assess severity ........................................................................................................................... 8 Uncomplicated malaria ...................................................................................................................................................... 9 Referral criteria .................................................................................................................................................................... 9 Severe malaria .................................................................................................................................................................. 10 1. Introduction ................................................................................................................................................. 11 2. Malaria treatment objectives ..................................................................................................................... 12 3. Parasite species .......................................................................................................................................... 12 4. Risk groups ................................................................................................................................................. 12 5. Clinical presentation and diagnosis ......................................................................................................... 13 5.1. Malaria transmission ............................................................................................................................................ 13 5.2. Symptoms and signs ............................................................................................................................................ 14 5.3. Laboratory diagnosis ............................................................................................................................................ 15 5.4. Referral criteria ...................................................................................................................................................... 17 5.5. Malaria notification ................................................................................................................................................ 17 6. Management of uncomplicated malaria ................................................................................................... 20 6.1. Uncomplicated P. falciparum malaria ................................................................................................................ 20 6.1.1. Chemotherapy ............................................................................................................................. 20 6.1.1.1. Artemether-lumefantrine ......................................................................................................... 20 6.1.1.2. Quinine ......................................................................................................................................... 23 6.1.2. General management ................................................................................................................. 24 6.1.3. Patient information for outpatient treatment ............................................................................ 24 6.2. Treatments not recommended for P. falciparum malaria ............................................................................... 26 6.3. Reducing the transmissibility of treated P. falciparum infections in areas of low intensity transmission 26 6.4. Treatment of non-falciparum infections ............................................................................................................. 27 6.5. Treatment of mixed Plasmodium species infections ....................................................................................... 29 7. Management of severe malaria ................................................................................................................. 29 7.1. WHO definition of severe malaria....................................................................................................................... 29 7.2. Management of severe malaria at the PHC level ............................................................................................ 30 7.2.1. Pre-transfer antimalarial drug treatment .................................................................................. 30 7.2.2. Pre-transfer general management............................................................................................ 30 7.3. Management of severe malaria at the hospital level ....................................................................................... 30 7.3.1. Initial clinical assessment and management .......................................................................... 31 7.3.2. Chemotherapy ............................................................................................................................. 31 7.3.2.1. Artesunate ................................................................................................................................ 31 7.3.2.2. Quinine ...................................................................................................................................... 32 7.3.3. General management ................................................................................................................. 34 7.4. Fluid management in severe malaria ................................................................................................................. 35 7.5. Management of malaria complications .............................................................................................................. 36 7.5.1. Severe malarial anaemia ........................................................................................................... 36 7.5.2. Hypoglycaemia ............................................................................................................................ 36 7.5.3. Cerebral malaria .......................................................................................................................... 37 7.5.4. Renal failure ................................................................................................................................. 37 7.5.5. Circulatory collapse ..................................................................................................................... 38 7.5.6. Metabolic acidosis ....................................................................................................................... 40 7.5.7. Respiratory distress .................................................................................................................... 41 7.5.8. Hepatic dysfunction ..................................................................................................................... 41 7.5.9. Bleeding ........................................................................................................................................ 42 7.5.10. Secondary infections ............................................................................................................... 42 7.5.11. Hyperparasitaemia .................................................................................................................. 43 7.5.12. Malarial haemoglobinuria ....................................................................................................... 43 7.5.13. Splenic rupture ......................................................................................................................... 44 8. Treatment of malaria in high-risk groups ................................................................................................ 44 8.1. Pregnancy .............................................................................................................................................................. 44 8.1.1. Diagnosis of malaria in pregnancy ........................................................................................... 44 8.1.2. Management of uncomplicated malaria in pregnancy ........................................................... 45 8.1.3. Management of severe malaria in pregnancy .......................................................................
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